Page 170 - GHES-2-4

Global Health Economics and
Sustainability
Evaluation of mental health law in Chile

Table 1. Total individual health plans and with coverage constraints in MH, according to the commercial situation as of January 2022
Insurer Total individual health plans Individual health plans with MH coverage % MH coverage constraint
constraint
Not on sale On sale Total Not on sale On sale Total Not on sale On sale
Colmena 3,203 152 3,355 3,199 152 3,351 99.88 100.00
Cruz Blanca 9,701 256 9,957 8,249 256 8,505 85.03 100.00
Vida Tres 6,566 105 6,671 3,252 105 3,357 49.53 100.00
Nueva Masvida 3,601 157 3,758
Banmédica 11,652 288 11,940 5,326 288 5,614 45.71 100.00
Consalud 4,818 339 5,157
Total 39,541 1,297 40,838 20,026 801 20,827 50.6 61.8
Source: Superintendence of Health, Health Plan Master File.
Abbreviation: MH: Mental health.

By 2022, 6.1% of the total billed at the system level consultations have coverage ranging from 25% to 35%,
corresponds to services related to MH; however, the total depending on the Isapre. In contrast, the remaining
covered by insurers represents only 4.2% of the total, which consultation types showed that the average coverage levels
is correlated in terms of copayments, where the weight of were approximately 13 percentage points (pp) higher
MH rises to 9.3%. (associated with emergency medicine), with many already
Two phenomena can be observed in terms of the reaching around 58% average coverage (associated with
components of MH expenditure. On the one hand, the adult neurology, internal medicine, and dermatology).
adequate coverage of the GES amounted to 95.2% in Table 3 presents the consultations associated with
2
2021 (95.7% in 2022), reflecting absolute financial protection telemedicine, showing a similar reality concerning face-
for individuals who used coverage for health problems, to-face consultations. The average effective coverage of
entirely in line with the WHO’s proposal to reduce OOP medical consultations other than MH shows values between
health expenditure. Conversely, there is low inpatient and 60% and 70%, well above those of MH consultations whose
outpatient financial coverage of what is not covered by the coverage fluctuates between 30% and 40%.
GES (i.e., the coverage provided for each health plan to At the system level, telemedicine medical consultations
MH services). This situation represents a clear disincentive have higher coverage than face-to-face consultations in all
to seek care, given that the low coverage generates a high analyzed specialties. Notably, higher effective coverage of
impact on the family budget for the first care and eventual MH consultations than face-to-face consultations under
treatment of the mental disorders. This impact is expected telemedicine (between 5 and 11 pp) occurs in all Isapres, with
to increase in the post-pandemic situation and the cooling Consalud standing out (between 12 and 22 pp). This fact is
of the economy, with the usual impact on the labor market particularly relevant for MH since some key factors limiting
and, therefore, on disposable income (WHO, 2011). access and adherence to treatment include stigma and OOP

3.1.1. Outpatient and inpatient services expenses. In the case of telemedicine, these disparities can
be attributed to consultations with more effective financial
The population analyzed in this section corresponds to the coverage than face-to-face consultations, with a nascent
entire portfolio of insured insurers (i.e., contributors and virtuous circle that should be analyzed and strengthened.
charges).
Table 4 presents the analysis of bed days, indicating a
Table 2 presents the average effective financial coverage similar reality to that described for outpatient MH services.
in medical consultations associated with MH (which The most critical MH bed day in expenditure (psychiatry
represents the gateway to the care system) versus medical hospitalization bed day) also shows the lowest effective
consultations of other specialties in 2021. Psychiatry financial coverage among all beds (20%). In comparison,
medical consultations show the lowest effective financial the next bed day shows an average effective coverage close
coverage (between 20% and 35% depending on the Isapre) to 69.8% (surgery hospitalization bed day).
of all medical specialties. Similarly, clinical psychology
3.1.2. Sick leaves
2 GES is a mandatory guaranteed plan for health insurance, In this subsection, the population analyzed corresponds to
i.e., it is a UHC plan. contributors, i.e., those who use sick leave.

Volume 2 Issue 4 (2024) 4 https://doi.org/10.36922/ghes.3408